title: Reduction in functional ability is significant postliver transplantation compared with matched liver disease and community dwelling controls.
abstract: We compared functional ability and symptom severity in liver transplant recipients and matched chronic liver disease (CLD) and community controls. A total of 103/140 consecutive liver transplant recipients from a single centre (73%) and matched controls completed the patient-reported functional outcome measure: Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire (PROMIS HAQ). Symptoms frequently seen in CLD were quantified by (i) Fatigue Impact Scale (FIS), (ii) Orthostatic Grading Scale (OGS: autonomic dysfunction), (iii) Cognitive Failures Questionnaire (CFQ) and (iv) Epworth Sleepiness Scale (ESS: Daytime somnolence). Liver transplant recipients exhibited significant reduction in function (P<0.0001) across all domains of the PROMIS HAQ suggesting that functional impairment is broad-based. Seventy-seven per cent of all postliver transplants identified some difficulty with activities of daily living. There was no relationship between PROMIS HAQ and liver biochemistry (r²=0.04, P=NS) or time since transplant (r² =0.1, P=NS). Elevation in PROMIS HAQ (and therefore functional impairment) strongly associated with symptoms, particularly fatigue, cognitive impairment and daytime somnolence. Fatigue severity was independently associated with functional impairment (FIS) (Beta 0.727, P < 0.0001). Symptoms or functional ability was not different between liver transplant recipients and matched chronic liver disease controls. Although survival postliver transplantation is improving, our cross-sectional study suggests that functional ability may not improve postliver transplantation. Further study is warranted to address the mechanisms responsible for post-transplant functional impairment and to develop effective rehabilitation regimes to maximize function following liver transplantation.
authors.affiliation: Institute of Cellular Medicine, Newcastle University Medical School, Newcastle-upon-Tyne, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Elliott
authors.forename: James
authors.initials: J
authors.lastname: Frith
authors.forename: Jessie
authors.initials: J
authors.lastname: Pairman
authors.forename: David E J
authors.initials: DE
authors.lastname: Jones
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
mesh_terms: D000203:Activities of Daily Living; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000503:physiopathology*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000534:rehabilitation; D008297:Male; D009290:Narcolepsy / Q000209:etiology; D011788:Quality of Life